The Centers for Medicare & Medicaid Services issued a request for information in October seeking input from all of its stakeholders on using artificial intelligence and other technologies to help process claims accurately, reduce administrative burdens on healthcare professionals and ensure Medicare program integrity.
“Since the Medicare program’s inception, the number and types of providers and suppliers have grown exponentially, as have the types of benefits available, the number of claims processed and paid and, perhaps most importantly, the number of dollars involved,” CMS officials said in the request. “All of these changes have raised the stakes for program integrity to historically high levels.”
In addition to focusing on ensuring program integrity, the request for information also sought input on expanding electronic health record (EHR) capabilities with artificial intelligence and machine learning.
“These tools hold the promise of more expeditious, seamless and accurate review of chart documentation during medical review to ensure that we are paying for what we get and getting what we pay for,” the agency said. CMS is also concerned that its old data storage and analytics systems don’t talk to each other, and says it hopes to receive submissions that will offer ways to make them work together and make it easier for them to find and fix program integrity problems.
Comments on the use of artificial intelligence and other advanced technologies in CMS integrity were accepted until Nov. 20, 2019.
“We have a number of disparate and disconnected legacy data systems and repositories,” CMS said. “On their own, each of them served or serves its purpose, but the future requires that we be able to join these disparate systems and bring them to bear in the fight against fraud, waste and abuse without creating entirely new data systems.”
From the December 2019 Issue of McKnight's Long-Term Care News
